USACC Form 104-R, Planned Academic Program Worksheet Completed Form Examples and Samples
Find a detailed example of a filled USACC Form 104-R, the Planned Academic Program Worksheet. This sample shows ROTC cadets how to correctly complete their academic plan, integrate MSL courses, and get the necessary signatures. Perfect for understanding the 104-R form requirements.
USACC Form 104-R Example – Planned Academic Program Worksheet
How this form was filled:
This example shows a properly filled out USACC Form 104-R for a fictional ROTC cadet, Jane A. Smith, majoring in Computer Science. It details her personal information, university, degree requirements, and a semester-by-semester course plan that integrates required Military Science (MSL) courses to ensure timely graduation and commissioning. The form includes the necessary signatures from the cadet, academic advisor, and Professor of Military Science (PMS).
Information used to fill out the document:
- Last Name: Smith
- First Name: Jane
- Middle Initial: A.
- University/College: State University
- Major: Computer Science
- Degree Pursued: Bachelor of Science
- Minor: N/A
- Academic Year: 2026-2027
- Current Term: Fall 2026
- Expected Graduation Date: 15 MAY 2028
- Total Credit Hours Required: 124
- Academic Advisor/Counselor Name: Dr. Robert Chen
- ROTC Instructor/PMS Name: LTC Michael Williams
- Date of Counseling: 25 OCT 2026
What this filled form sample shows:
- Clearly defined personal and academic information at the top of the form.
- A comprehensive semester-by-semester course plan that includes course numbers, titles, and credit hours.
- Integration of mandatory Military Science (MSL) courses and labs into the academic schedule.
- Proper completion of signature and date blocks for the Cadet, Academic Advisor, and ROTC Instructor.
Form specifications and details:
| Form Name: | USACC Form 104-R |
| Form Title: | Planned Academic Program Worksheet |
| Issuing Agency: | U.S. Army Cadet Command (USACC) |
| Use Case: | An ROTC Cadet planning their full academic degree path to ensure all requirements for graduation and commissioning are met on schedule. |
Created: February 12, 2026 04:59 AM
